基于《临证指南医案》探讨角药在脾胃病中的运用

Exploration on the application of triangular drugs in spleen and stomach diseases based on Clinical Guidelines and Medical Records

角药作为中医药理论指导下的由三药组合而成的特殊用药形式,在临床使用中常获良效。《临证指南医案》中涵盖了大量叶天士治疗脾胃病的学术思想及经验,其中叶天士首创的“通补阳明”法、养胃阴学说、久病入络学说等对现世治疗脾胃病影响颇深,其尤重对胃的论治,认为用药需刚而不燥,柔而不腻,强调通降而顺其用。通过对《临证指南医案》中角药的系统梳理,从温补胃阳、滋阴润胃、益气降逆、养血通络、脾胃同调、两和肝胃六方面论述脾胃病中角药的特点,并举验案一则,以期更好理解角药的配伍并将其运用于临床中。

As a special drug form composed of three drugs under the theory of traditional Chinese medicine,triangular drugs often achieves good clinical effect.Clinical Guidelines and Medical Records covers a large number of YE Tianshi's academic thoughts and experience in the treatment of spleen and stomach diseases,among which YE Tianshi's first'tonic yang ming'method,the theory of nourishing stomach yin,the theory of chronic disease into the collateral,etc.,has a profound impact on the modern treatment of spleen and stomach diseases,especially the treatment of stomach,that the drug should be rigid but not dry,soft but not rich,emphasizing the use of Tongjiang.Based on the systematic review of triangular drugs in Clinical Guidelines and Medical Records,the characteristics of triangular drugs in spleen and stomach diseases were discussed from six aspects:warming and tonifying stomach yang,nourishing yin and moistening stomach,supplementing qi and lowering inverse,nourishing blood and clearing collaterals,harmonizing spleen and stomach,and liver and stomach,and gives a case in order to better understanding and applying them in clinical practice.